照顧一位腭裂足月兒及其主要照顧者之護理經驗

Nursing Experience of A Term Baby with Cleft Palate and Their Caregiver

本文主要探討一位腭裂足月兒及其主要照顧者之護理經驗，過程發現家屬面對個案先天性腭裂情形有所複雜情緒糾結，面對返家後續照護更是有所畏懼，故引發筆者想深入探討。筆者自2021年8月22日至9月19日期間，經由觀察、身體評估、會談及與父母親互動等方式來收集資料，依生理、心理、靈性及社會層面進行整體性護理評估，個案有呼吸道清除功能失效、潛在危險性肺吸入、案母有照顧者角色緊張等健康問題。針對個案給予胸腔物理治療及嗆奶處理等個別性的護理措施；而對於案父母在學習過程中產生退縮及緊張情緒，提供以家庭為中心的照護，給予彈性會客時間、一對一的回覆示教及適時給予家屬鼓勵與支持，提升其學習意願，並能減輕心理壓力及緊張情緒，更能強化個案與父母間的親子關係，亦使照顧者有足夠信心及照護能力，讓個案出院也能得到完善照護。先天性缺陷兒後續返家追蹤照護是很需要的，建議院方能增設相關個管人員來追蹤並強化後續返家後的護理指導，並藉此經驗分享提供相關照護之參考。

The study aims to share a nursing experience of a term baby with congenital cleft palate from August 22 to September 19, 2021. The parents of the case got complex when faced with the situation, therefore, they are afraid of follow-up care after returning home. This observation triggers the author’s motivation for further discussion. Collecting data through observation, physical evaluations, interviews, and interaction with parents, and conducting a complete nursing assessment according to physical, psychological, spiritual, and social aspects to identify problems, including ineffective airway clearance, potentially dangerous lung aspiration, and the case mother had problems in her health due to the caring pressure. We provided individual nursing such as chest care and choking management. For stressed and anxious parents, we provided a family-centered service, flexible meeting time, one-on-one teaching, and appropriate encouragement and support to improve their willingness to learn. Those procedures can also reduce anxiety and strengthen the parent-child relationship, so that the case can be well-cared after returning home. To take care of such cases, it is suggested that there should be a hospital case manager to follow up and provide nursing guidance after returning home. This study was expected to provide a reference for those work with newborns with cleft palate cases.